Aniejurengho, C.Toritsetse, Melaundra Floyd, Frederika Robinson, and Joyce Conley
STATEMENT OF THE PROBLEM
ARDS is a sudden, life-threatening lung failure that inflames the alveoli, causing them to fill with liquid and collapse. ARDS requires treatment with mechanical ventilation or some other form of assisted breathing. The main aim of this literature review was to determine if recruitment maneuver with PEEP or PEEP alone could reduce morbidity in mechanically ventilated patients with ARDS and ALI.
“In the management of ventilated patients with ARDS, what is the effect of recruitment maneuver with PEEP on morbidity compared with PEEP alone?”
SEARCH FOR EVIDENCE
A comprehensive search of MEDLINE, CINAHL, PUBMED and Cochrane databases were completed to find articles on the clinical question. Six articles were retained for review, within the 5-year deadline. The inclusive criteria used in conducting these searches were ARDS, ALI, respiratory distress, recruitment maneuver, PEEP, mechanical ventilation, mortality and morbidity rate. Furthermore, key words, such as experimental study, randomized control trial, and clinical trial were used to set limits on this search. For studies to be retained for review, they must be evaluating the effectiveness of PEEP and/or PEEP with recruitment maneuver on patients with ARDS or ALI.
Currently there are no practices guidelines for the use of recruitment maneuver with PEEP
The majority of the studies appraised found that recruitment maneuver revealed a short-term improvement on oxygenation, but does not have an impact on long-term outcome. Recruitment maneuvers with PEEP in ARDS minimize the barotraumas in this life-threatening clinical problem.
CLINICAL PRACTICE IMPLICATIONS
Well-defined clinical outcomes with more robust clinical trials are required to clarify the outcome benefit of this approach. Until then, recruitment maneuvers, including PEEP, could be considered for individuals with ALI and ARDS, with the understanding that, though oxygenation may improve, there is yet no documented morbidity benefit.